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General NPI Number Information
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NPI Number | 1740988930
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Entity Type | Individual
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Provider Name | SHANNA KORNEGAY CORLEY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 702 NEWMAN RD
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City | NEW BERN
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State | NC
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Zip | 28562-5238
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Country | US
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Telephone | 252-633-5333
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Fax | 252-633-9443
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Provider Business Mailing Address
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Address Line | P.O. BOX 12248
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City | NEW BERN
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State | NC
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Zip | 28561-2248
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Country | US
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Telephone | 252-514-6685
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Fax | 252-514-2745
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5017703
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License Number State | NC
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